Adiposity, Skeletal Muscle Mass and Handgrip Strength in Relation to Hepatic Steatosis and Liver Fibrosis in Individuals with Type 2 Diabetes Mellitus: A Dual-Energy X-ray Absorptiometry and Transient Elastography Study

<title>Abstract</title> <p> <bold>Background &amp; Aims</bold> Type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) share adiposity and insulin resistance as common soil, and altered body composition — the coexistence of excess fat with impaired skeletal muscle — has been implicated in the progression of liver disease. We characterised body composition, visceral adiposity and muscle function in adults with T2DM and examined their relationships with hepatic steatosis and liver fibrosis. <bold>Methods</bold> In this single-centre cross-sectional study, 150 adults with T2DM underwent whole-body dual-energy X-ray absorptiometry (DXA) to quantify total and appendicular skeletal muscle mass, muscle mass index, total body fat and visceral adipose tissue. Handgrip strength was measured by dynamometry. Hepatic steatosis (controlled attenuation parameter, CAP) and liver stiffness (liver stiffness measurement, LSM) were assessed by vibration-controlled transient elastography. Associations were examined by Pearson correlation and across fibrosis strata. <bold>Results</bold> The cohort (80% male; mean age 53.6 years; mean body mass index 28.1 kg/m²) had a mean total body fat of 34.1%, appendicular skeletal muscle mass index of 7.29 kg/m² and visceral adipose tissue of 769.6 g. Total body fat correlated significantly with both CAP (r = 0.420, p &lt; 0.001) and LSM (r = 0.329, p &lt; 0.001). Height-indexed muscle mass rose with adiposity and correlated positively with CAP (r = 0.295, p = 0.015) and LSM (r = 0.243, p = 0.046). Body mass index, waist circumference and total body fat increased stepwise across LSM strata (body fat 33.2%, 37.0% and 40.4% for LSM &lt; 8, 8–12 and &gt; 12 kPa). In contrast, participants with a higher serum fibrosis score (FIB-4 ≥ 1.3) were leaner but had lower handgrip strength (right hand 24.8 vs 28.3 kg), revealing a dissociation between muscle quantity and muscle function. <bold>Conclusions</bold> In T2DM, greater total and visceral adiposity is closely associated with elastography-defined hepatic steatosis and fibrosis, whereas absolute muscle mass rises with obesity yet muscle function declines with advancing fibrosis risk. This quantity–quality dissociation is consistent with a sarcopenic-obesity phenotype and argues for incorporating both adiposity and muscle-function assessment into liver risk stratification in diabetes. </p>